Challenging operating environments are countries or regions characterized by:
Poor access to health services; and
Man-made or natural crises.
How is a country classified as a challenging operating environment?
The Global Fund Secretariat has devised a composite risk index based on a combination of ten indices published by various organizations. This index compiles authoritative data that highlights the economic, governance, operational and political risks in a country. The Global Fund Risk Index is updated annually and published on the Global Fund website, according to the policy adopted by the 35th Board in 2016.
For example, South Sudan was classified as a COE when the COE policy was adopted in 2016; Ukraine was added to the list recently when war broke out in the country in February 2022.
What is the purpose of the COE policy?
The Global Fund adopted the Challenging Operating Environment Policy in 2016 with a view to systematically improving the effectiveness of its investments in these countries through:
Increased flexibility and;
Which countries are currently classified as COEs?
West and Central Africa
East and Southern Africa
Burkina Faso, Central African Republic, Chad, Congo (Democratic Republic), Guinea, Guinea-Bissau, Liberia, Mali, Niger, Nigeria, and Sierra Leone
*Refers to other countries in the East Mediterranean constituency
Are there only benefits for a country to be classified as a COE?
There are some benefits as mentioned above. Many of these countries are emerging from civil war or are experiencing insecurity or simmering conflicts in parts of the country. Consequently, challenging operating environments are often associated with State weakness, poor financial control systems, opportunistic or systemic fraud. As a result of these weaknesses, most COE countries are also subject to risk mitigation measures such as additional safeguard policies with or without the presence of fiscal agents or international organizations acting as implementers. These measures often undermine country ownership because the above-mentioned actors that support country capacity often do not transfer knowledge, thereby making countries dependent on such assistance.
On the other hand, several countries whose risk level has been reduced and that are no longer classified as COEs, still have these safeguard measures in place even though they have lost the benefits associated with COEs.
Some Examples of Innovation, Flexibility, and Partnership in Challenging Operating Environments
At a meeting organized by the African Constituency Bureau on the issue of COEs, participating countries shared some examples of flexibility, innovation, and partnership under COE policies.
Flexibility: In Niger, the country could use the valuing of government health expenditures as evidence of co-financing. This is consistent with the policy of sustainability, transition, and co-financing for low-income countries.
In the DRC, the Global Fund accepted an “Activities-based contracting” approach at the health district level. This contracting approach makes it easier to implement activities in areas where a shortage of health workers compounds administrative concerns about obtaining and properly classifying receipts and other supporting documentation.
Innovation: In South Sudan, with support from the Global Fund, discussions with parliamentarians have been initiated to put in place domestic resource mobilization laws.
In Nigeria, multi-month dispensing of antiretrovirals (ARVs) has improved treatment adherence and retention of patients on treatment.
Partnership: In Mali, as part of the implementation of the COE policy, the Global Fund Secretariat partnered with humanitarian organizations to provide services to populations in areas where the Malian State is absent. Reporting and other administrative requirements are lighter with these new partners.
We note the wide range of measures relating to the Global Fund’s procedures and policies.